COVID-19 disease is a highly infectious disease caused by a newly (novel) identified coronavirus. COVID-19 infected patients may have mild to moderate respiratory symptoms and can recover without any specific medical management. But few experience severe symptoms and lead to mortality. COVID-19 is announced by WHO as a global pandemic. It is very critical to take appropriate decisions and timely management and prevention of the infection. Keywords: COVID-19, Diagnostic test, Management of COVID19, Pandemic, Pathophysiology, Signs, Symptoms.

1. REVIEW ARTICLE
A Global Threat COVID-19: Understanding and its
Management
Puvaneswari Kanagaraj1
, Anbueswari Kanagaraj2
, Albin Joseph Yesuwilson3
Abstract​
COVID-19 disease is a highly infectious disease caused by a newly (novel) identified corona virus. COVID-19 infected patients may have mild to
moderate respiratory symptoms and can recover without any specific medical management. But few experience severe symptoms and lead to
mortality. COVID-19 is announced by WHO as a global pandemic. It is very critical to take appropriate decisions and timely management and
prevention of the infection.
Keywords: COVID-19, Diagnostic test, Management of COVID19, Pandemic, Pathophysiology, Signs, Symptoms.
Pondicherry Journal of Nursing (2020): 10.5005/jp-journals-10084-12143
Introduction​
Corona viruses can affect birds, mammals, and also human beings
(identified in 1960).1
The term “Corona virus” is obtained from a
word “Corona” from Latin meaning “crown” or “wreath.”2
Some of
the corona infections identified were SARS-CoV (2003), HCoV NL63
(2004), and MERS-CoV (2012).3
On February 11, 2020, the WHO has
announced unexplained low respiratory infections detected in
Wuhan city, China, i.e., named as “Coronavirus disease 2019,” an
acronym of COVID-19, which is caused by a novel CoV.4
Definition​
COVID-19isapandemicdiseasecausedbyCOVID-19orSARS-CoV-2,
whichisgeneticallysimilartothesevereacuterespiratorysyndrome
(SARS) coronavirus.5
Transmission​, Incubation​Period, and​
Vulnerable​Groups​
COVID-19primarilyspreadsthroughtherespiratorytractbydroplets
(coughandsneeze),respiratorysecretions,anddirectcontact.6
People
become infected with COVID-19 by touching the contaminated
objects or surfaces with COVID 19, then touching their eyes, nose, or
mouth.7
COVID-19 infection has an incubation period of 1–14 days,
mostly 3–7 days.8
It is highly transmissible in humans. People who
are older or who have existing chronic medical conditions, such
as hypertension, compromised lung function, chronic obstructive
pulmonary disease or diabetes, cancer, or who have compromised
immune systems may be at higher risk of serious illness.9–11
Pathophysiology​4,12–14
A pathophysiology and virulence mechanism of COVID-19 has a
link to the function of structural and nonstructural proteins. The
pathophysiology is explained in Flowchart 1.
Clinical​Manifestations​/Syndromes in​
Adults​15,16
The clinical features of coronavirus disease-19 can vary from
asymptomatic to severe clinical conditions. Clinical syndromes are
explained in Figure 1.
Diagnostic​Tests
17,18
Use appropriate personal protective equipment (PPE) while taking
specimens like blood, upper, and lower respiratory samples.
Follow droplet, contact, and airborne precautions. It is explained
in Figure 2.
Management​15,16
Clinical Management15,16
Infection Prevention and Control Measures
• Infection prevention and control (IPC) measures need to be
initiated along with the screening and give a mask to the
suspected COVID-19 and direct to separate area with 1-m
distance between patient to patient.
• Healthcare workers should follow the standard precautions
(handhygiene,appropriatePPE,biomedicalwastemanagement,
prevention of needle-stick injury, cleaning and disinfection of
equipment and environment when in contact with body fluids,
blood, secretions (respiratory), and nonintact skin both directly
or indirectly.
1
Department of Medical and Surgical Nursing, Narayana Hrudayalaya
College of Nursing, Bengaluru, Karnataka, India
2
Department of Nursing, Government Mohan Kumaramangalam
Medical College and Hospital, Salem, Tamil Nadu, India
3
Department of Nursing, Aliaa Specialist Hospital, Omdurman,
Khartoum, Sudan
Corresponding Author: Puvaneswari Kanagaraj, Department of
Medical and Surgical Nursing, Narayana Hrudayalaya College of
Nursing, Bengaluru, Karnataka, India, Phone: +91 9448126938, e-mail:
puvaneswariramesh@gmail.com
How to cite this article: Kanagaraj P, Kanagaraj A, Yesuwilson AJ.
A Global Threat COVID-19: Understanding and its Management. Pon
J Nurs 2020;13(1):18–21.
Source of support: Nil
Conflict of interest: None
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org/licenses/by-nc/4.0/),whichpermitsunrestricteduse,distribution,andnon-commercialreproductioninanymedium,providedyougiveappropriatecreditto
theoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicense,andindicateifchangesweremade.TheCreativeCommonsPublicDomain
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2. A Global Threat COVID-19: Understanding and its Management
Pondicherry Journal of Nursing, Volume 13 Issue 1 (January–March 2020) 19
Mild COVID-19 Management: Monitoring and Symptomatic
Treatment
• COVID-19 patients with mild symptoms need isolation and can
be managed without hospitalization.
• Treat symptomatically with antipyretics for fever. Patients
should be counseled about the clinical features of the
complicated illness and advised to seek the medical
help.
SevereCOVID-19Management:MonitoringandOxygenTherapy
• Observe the signs of clinical deterioration of progressive
respiratory failure, sepsis closely, and treat immediately. Patients
with SARI along with no evidence of shock, conservative fluid
management should be used cautiously.
• Administersupplementaloxygentherapy(5L/min)immediately
for patients identified with hypoxemia, respiratory distress,
SARI, or shock
Flowchart 1: Pathophysiology of COVID-19
Fig. 1: Clinical syndromes associated with COVID-19

3. A Global Threat COVID-19: Understanding and its Management
Pondicherry Journal of Nursing, Volume 13 Issue 1 (January–March 2020)20
Severe COVID-19 Management: Treatment of Coinfections
• Administerantimicrobials/antibioticstotreatpathogenscausing
SARI and sepsis within one hour of initial assessment of patients
with sepsis.
ARDS and Hypoxemic Respiratory Failure Management
• High flow nasal cannula oxygenation (HFNC) or noninvasive
mechanical ventilation need to be started. And if the symptoms
do not improve, endotracheal intubation and invasive
mechanical ventilation need to be initiated.
• Implement mechanical ventilation (prone ventilation for >12
hours per day) using lower tidal volumes (4–8 mL/kg predicted
body weight) and lower inspiratory pressures (plateau pressure
<30 cm H2O). Deep sedation may be needed. For patients with
ARDS(moderate/severe),higherpositiveendexpiratorypressure
(PEEP) is recommended instead of lower PEEP.
• Extracorporeal life support (ECLS) or (ECMO) can be performed
if needed.
Septic Shock Management
• Standard care includes early recognition of symptoms and start
treating within one hour with antimicrobial therapy and fluid
loading for hypotension.
• To maintain the mean arterial pressure ≥65 mm Hg and lactate
lessthan2mmol/L,intheabsenceofhypovolemia,vasopressors
are recommended. Administer isotonic crystalloid 30 mL/kg in
adults in the first three hours as a rapid bolus and up to 40–60
mL/kginfirst1hour.Donotusehypotoniccrystalloids,starches,
or gelatins for resuscitation.
Other Therapeutic Measures
• For patients with progressive deterioration of oxygenation
indicators,rapidworseningonimagingandexcessiveactivation
of the body’s inflammatory response, and glucocorticoids
(methylprednisolone 1–2 mg/kg/day) can be used for a short
period (3–5 days).
• Oseltamivir 75 mg (BD × 5d), azithromycin 500 mg (OD ×
5d), HCQ 400 mg OD on first day, 200 mg BD × 4d are the
recommendation in India, unless it is contraindicated for the
patients.
Prevention of Complications
Fig. 2: Diagnostic tests related to COVID-19
Invasive mechanical
ventilation–reduction
• Use weaning protocols
• Minimize continuous or
intermittent sedation
Ventilator-associated
pneumonia
• Prefer oral intubation and keep
patient in semirecumbent
position (head of bed elevation
30–45°)
• Use a closed suctioning system
periodically drain and discard
condensate in tubing, use
a new ventilator circuit for
each patient and change heat
moisture exchanger when it
malfunctions or soiled.
Venous thromboembolism • Use low molecular-weight
heparin/heparin 5,000 units SC
twice daily
• Use intermittent pneumatic
compression devices.
Catheter-related bloodstream
infection
• Use a checklist with completion
verified by a real-time observer.
• Remove catheter if no longer
needed.
Stress ulcers and GI bleeding • Give early enteral nutrition
(24–48 hours of admission)
• Administer proton-pump
inhibitors/histamine-2 receptor
blockers
ICU-related weakness • Actively mobilize the patient
early in the course of illness
when safe to do so

4. A Global Threat COVID-19: Understanding and its Management
Pondicherry Journal of Nursing, Volume 13 Issue 1 (January–March 2020) 21
Discharge Criteria from the Hospital
15,16
• Patient clinically stable
• Radiologically clear
• Two negative samples taken 24 hours apart
Complications​16,19
Respiratory distress syndrome, septic shock, acute liver injury,
metabolic acidosis, acute cardiac injury, coagulation dysfunction,
and multiorgan failure.
Preventive​Measures​5,13
• Vaccines are under trial as of now.
• Hygiene (hand, respiratory, and toilet), social distancing, and
limiting contact with symptomatic people are the preventive
measures to be followed by individuals.
• Appropriate use of PPE and addition of airborne precautions
(N95/FFP2/3 if AGP) while performing aerosol-generating
procedures need to be followed by the healthcare workers.
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